Implementation of Coordinated Spontaneous Awakening and Breathing Trials Using Telehealth-Enabled, Real-Time Audit and Feedback for Clinician AdHerence: A Type II Hybrid Effectiveness-Implementation

使用支持远程医疗的实时审核和临床医生依从性反馈来实施协调的自发觉醒和呼吸试验：II 型混合有效性实施

• 批准号: 10315222
• 负责人: Colin Kerst Grissom
• 金额: $ 61.97万
• 依托单位: IHC HEALTH SERVICES, INC.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10315222
• 关键词: Absence of pain sensation; Acute respiratory failure; Adherence; Adopted; Breathing; COVID-19; Caring; Clinical; Clinical Trials; Clinical effectiveness; Cluster randomized trial; Cognitive; Communication; Communities; Complex; Computerized Medical Record; Consolidated Framework for Implementation Research; Critical Care; Critical Illness; Delirium; Effectiveness; Event; Evidence based practice; Feedback; Goals; Guidelines; Healthcare; Hospitals; Institution; Intensive Care; Intensive Care Units; Interruption; Intervention; Knowledge; Lead; Length of Stay; Lung; Measures; Mechanical Ventilators; Mechanical ventilation; Monitor; Movement; Nurses; Outcome; Oxygen Consumption; Pain; Patient Monitoring; Patient-Focused Outcomes; Patients; Performance; Periodicity; Persons; Physicians; Positioning Attribute; Protocols documentation; Provider; Randomized; Recovery; Research; Respiratory Failure; Risk; Sampling; Sedation procedure; Site; System; Testing; Time; Ventilator; Work; arm; care systems; clinical decision support; dashboard; data sharing; effectiveness implementation study; effectiveness implementation trial; follow-up; implementation strategy; improved; improved outcome; mortality; novel; prospective; provider adherence; remote health care; remote monitoring; respiratory; telehealth; ventilation; ventilator-associated pneumonia; Absence of pain sensation; Acute respiratory failure; Adherence; Adopted; Breathing; COVID-19; Caring; Clinical; Clinical Trials; Clinical effectiveness; Cluster randomized trial; Cognitive; Communication; Communities; Complex; Computerized Medical Record; Consolidated Framework for Implementation Research; Critical Care; Critical Illness; Delirium; Effectiveness; Event; Evidence based practice; Feedback; Goals; Guidelines; Healthcare; Hospitals; Institution; Intensive Care; Intensive Care Units; Interruption; Intervention; Knowledge; Lead; Length of Stay; Lung; Measures; Mechanical Ventilators; Mechanical ventilation; Monitor; Movement; Nurses; Outcome; Oxygen Consumption; Pain; Patient Monitoring; Patient-Focused Outcomes; Patients; Performance; Periodicity; Persons; Physicians; Positioning Attribute; Protocols documentation; Provider; Randomized; Recovery; Research; Respiratory Failure; Risk; Sampling; Sedation procedure; Site; System; Testing; Time; Ventilator; Work; arm; care systems; clinical decision support; dashboard; data sharing; effectiveness implementation study; effectiveness implementation trial; follow-up; implementation strategy; improved; improved outcome; mortality; novel; prospective; provider adherence; remote health care; remote monitoring; respiratory; telehealth; ventilation; ventilator-associated pneumonia

PROJECT SUMMARY Although invasive mechanical ventilation (IMV) is a lifesaving treatment for about 300,000 U.S. patients with acute respiratory failure each year, it is associated with significant risks. Spontaneous awakening and breathing trials during IMV improve patient outcomes. Coordination of spontaneous awakening and breathing trials (C-SAT/SBT) is complex and significant barriers to implementation exist and adherence with C-SAT/SBT across institutions is highly variable. Although national guidelines recommend daily coordinated C-SAT/SBT in IMV patients they are underused. Telehealth-enabled remote care is positioned to improve C-SAT/SBT use. At Intermountain Healthcare, we have system-wide tele-critical care services staffed by critical care physicians, nurses, and respiratory therapists who remotely monitor and assist with patients in ICUs using real-time audiovisual communication, a systemwide electronic medical record (EMR), electronic dashboards, and clinical decision support. We recently studied the impact of implementation strategies to improve evidence-based practices for lung protective ventilation (LPV) in 3 pilot ICUs, and then adopted a Telehealth-Enabled, real-time Audit and feedback for Clinician adHerence (“TEACH”) to disseminate LPV adherence strategies to the other 14 ICUs, achieving over 90% adherence (NCT 03984175). This successful approach could help identify candidates for C-SAT/SBT protocols, prompt bedside providers to perform C-SAT/SBT, and guide execution. The specific aims of this research are to (1) adapt baseline implementation strategies and to target C- SAST/SBT using the Consolidated Framework for Implementation Research; (2) conduct a type II cluster- randomized hybrid effectiveness-implementation trial to compare a usual audit and feedback implementation approach to a usual audit and feedback implementation approach augmented with a Telehealth-Enabled, real- time Audit and feedback for Clinician adHerence (“TEACH”) to promote C-SAT/SBT; and (3) evaluate sustained adherence to the TEACH enhancement in the final year after the RCT has ended. Completion of this project will advance knowledge regarding the effective and sustainable strategies for C- SAT/SBT implementation specifically and the effectiveness generally of telehealth remote monitoring and prompting strategies to aid best practice implementation in ICUs. The proposed research builds on the study team’s existing work and has potential to develop more informed and effective care of persons with respiratory failure. Spread and scale of this telehealth-enabled, central monitoring of critical aspects of care for ICU patients is particularly important to study now, given the vulnerability of ICU staff to COVID-19 exposure.

项目摘要 尽管侵入性机械通气（IMV）是约300,000名美国患者的救生治疗 每年急性呼吸衰竭，它与重大风险有关。自发觉醒和 IMV期间的呼吸试验改善了患者的预后。赞助和呼吸的协调 试验（C-SAT/SBT）是复杂的，并且存在重大的实施障碍，并遵守C-SAT/SBT 整个机构之间的变化很大。尽管国家准则建议每天协调C-SAT/SBT IMV患者他们没有被没用。 支持远程医疗的远程护理可改善C-SAT/SBT使用。在Intermountain Healthcare，我们 拥有由重症监护医师，护士和呼吸系统的范围内的远程临界护理服务 远程监测和协助使用实时视听沟通的ICU患者的治疗师 系统范围的电子病历（EMR），电子仪表板和临床决策支持。我们 最近研究了实施策略以改善肺基于证据的实践的影响 3个试点ICU中的保护性通风（LPV），然后通过远程医疗的实时审计，并通过 临床医生遵守的反馈（“教学”）将LPV依从性策略传播给其他14个ICU， 达到超过90％的依从性（NCT 03984175）。这种成功的方法可以帮助确定候选人 C-SAT/SBT协议，及时的床旁提供商执行C-SAT/SBT以及指导执行。 这项研究的具体目的是（1）调整基线实施策略并针对C- SAST/SBT使用合并框架进行实施研究； （2）进行II型簇 - 随机混合有效性实施试验，以比较通常的审核和反馈实施 通过具有远程医疗的，现实的审计和反馈实施方法进行通常的审计和反馈实施方法 临床医生遵守的时间审核和反馈（“教”）促进C-SAT/SBT； （3）评估 RCT结束后的最后一年，持续遵守教学增强。 该项目的完成将促进有关C-有效和可持续策略的知识 SAT/SBT实施以及远程医疗远程监控的一般有效性和 促使策略有助于ICU中的最佳实践实施。拟议的研究以研究为基础 团队的现有工作，并有潜力开发出呼吸道患者更有效和有效的护理 失败。该远程医疗的分布和规模，对ICU关键方面的关键方面的中心监控 鉴于ICU员工对COVID-19暴露的脆弱性，现在研究患者尤其重要。